A Drug Study on
Rivastigmine
In Partial Fulfillment of the
Requirements in NCM 214– RLE
GERIATRICS NURSING ROTATION
Submitted to:
Mrs. Jo Ann Dela Cerna, RN, MN
Clinical Instructor
Submitted by:
Raijenne C. Versola, St.N
August 17, 2021
Generic Name: Rivastigmine
Brand name: Exelon
Classification: Acetylcholinesterase
inhibitor
Mode of Action: Increases
acetylcholine in CNS by inhibiting
hydrolysis by cholinesterase.
Dose and route:
Alzheimer’s Dementia (Mild to
Moderate)
PO: ADULTS, ELDERLY: Initially, 1.5 mg twice daily. May increase at intervals of
at least 2 weeks to 3 mg twice daily, then 4.5 mg twice daily, and finally 6 mg
twice daily. Maximum: 6 mg twice daily. Transdermal: Initially, 4.6 mg/24 hrs.
May increase at intervals of at least 4 weeks to 9.5 mg/24 hrs and then to 13.3
mg/24 hrs.
Alzheimer’s Dementia (Severe)
Transdermal: ADULTS, ELDERLY: Initially, 4.6 mg/24 hrs. May increase at
intervals of at least 4 weeks to 9.5 mg/24 hrs and then to 13.3 mg/24 hrs.
Parkinson’s Dementia
PO: ADULTS, ELDERLY: Initially, 1.5 mg twice daily. May increase at intervals of
at least 4 weeks to 3 mg twice daily, then 4.5 mg twice daily, and finally 6 mg
twice daily. Maximum: 6 mg twice daily. Transdermal Dosage: Note: Initially, 4.6
mg/24 hrs. May increase after 4 weeks to 9.5 mg/24 hrs and then to 13.3 mg/24
hrs.
Dosage in Renal Impairment
No dose adjustment.
Dosage in Hepatic Impairment
Oral: No dose adjustment. Transdermal: Maximum dose: 4.6 mg/24 hrs.
Indication:
Alzheimer’s Disease
Parkinson’s Disease Dementia
Contraindication:
Hypersensitivity to this product, other carbamates
Precautions:
Pregnancy Respiratory/Cardiac/Renal/Hepatic Disease
Breastfeeding Seizure disorder
Children Peptic Ulcer
Urinary Obstruction Asthma
Surgery GI Bleeding
Jaundice Increased Intracranial Pressure
Side effects and adverse effects:
Side Effects
Frequent (47%–17%): Nausea, vomiting, dizziness, diarrhea, headache,
anorexia.
Occasional (13%–6%): Abdominal pain, insomnia, dyspepsia (heartburn,
indigestion, epigastric pain), confusion, UTI, depression.
Rare (5%– 3%): Anxiety, drowsiness, constipation, malaise,
hallucinations, tremor, flatulence, rhinitis, hypertension, flu-like symptoms,
weight loss, syncope.
Adverse Effects
Overdose can produce cholinergic crisis, characterized by severe
nausea/vomiting, increased salivation, diaphoresis, bradycardia,
hypotension, respiratory depression, seizures.
Drug Interaction:
DRUG: May interfere with anticholinergics (e.g., dicyclomine,
glycopyrrolate, scopolamine) effects. May have additive effect with bethanechol.
NSAIDs may increase GI effects, irritation. HERBAL: Ginkgo biloba may
increase cholinergic effects. FOOD: None known. LAB VALUES: None
significant.
Nursing Responsibilities:
1. Monitor for cholinergic reaction: GI discomfort/ cramping, feeling of facial
warmth, excessive salivation, diaphoresis, lacrimation, pallor, urinary
urgency, dizziness.
Rationale: This is to take immediate actions and prevent further
complications or discomfort to the patient.
2. Monitor for nausea, diarrhea, headache, insomnia.
Rationale: These are common side effects that may occur as the body
adjusts to the drug.
3. Inform patient/ family to take the medication with meals (at breakfast,
dinner).
Rationale: To reduce side effects of stomach irritation, including
indigestion, stomach inflammation or ulcers.
4. Inform patient/ family to swallow capsule whole. Do not break, chew, or
divide capsules.
Rationale: As it was written in the instruction on how to properly use. If
swallowing is a problem, speak to the doctor about using either the liquid
form or the patch.
5. Monitor patient’s cognitive function and ability to perform ADLs.
Rationale: Being able to stabilize cognitive performance or ability to
maintain activities of daily living may be important clinically.
6. Monitor diabetics for loss of glycemic control.
Rationale: Weight loss in dementia patients with DM should be
approached carefully as it can act as a double-edged sword—improving
glycemic control on one side and increasing the potential for malnutrition
and hypoglycemia on the other.
7. Advise patient/family to not stop taking this medicine or decrease the dose
without first checking with their doctor.
Rationale: Stopping this medicine suddenly or decreasing the dose by a
large amount may cause mental or behavior changes.
8. Assistance with ambulation during beginning therapy; dizziness may
occur.
Rationale: Dizziness is the most common side effect of the drug. Thus,
patients need assistance to avoid possible injuries.
9. Advise the patient/ family to avoid use of beers in older adults.
Rationale: This may increase the risk of orthostatic hypotension or
bradycardia.
10. Report important details to the CI/ attending physician.
Rationale: It is essential to report to the CI/ physician for them to be aware
of the actions taken and response of the patient’s body to the drug.
Bibliography:
Kizior, R. & Hodgson, K. (2019). Saunders Nursing Drug Handbook. Elsevier.
ISBN: 978-0-323-60885-5.
RxList. (2020, November 2). Exelon. Retrieved August 17, 2021 from
[Link]
Skidmore, L. (2019). Mosby’s 2019 Nursing Drug Reference (32nd Edition).
Elsevier. ISBN: 978-0-323-60997-5.